Risk relationship resource allocation servicing system and method

ABSTRACT

A system may receive a first resource allocation request (associated with a first company) from a first entity. The system may determine that the first request is not associated with a risk relationship and arrange for it to be processed via a claim servicing entity. Information about the first request may then be routed to a request handler device for processing and a communication with a first graphical indication may be generated. The system may also receive a second resource allocation request (associated with the first company) from a second entity and determine that it is to be processed via a risk. The system may then route information about the second request to a request handler device for processing and generate a communication with a second graphical indication. Note that the request handler device may be the same device that received the information about the first request.

CROSS REFERENCE TO RELATED APPLICATION

This is a continuation of U.S. patent application Ser. No. 16/253,734,entitled “RISK RELATIONSHIP RESOURCE ALLOCATION SERVICING SYSTEM ANDMETHOD,” filed Jan. 22, 2019, the entire contents of which areincorporated herein by reference for all purposes.

BACKGROUND

It may be advantageous to protect against unexpected risks, such asthose associated with computer systems and/or risk relationshipagreements. For example, it might be advantageous for a company topurchase a typical insurance policy, such as a workers' compensationinsurance policy. Such policies generally have the insurer processclaims received from claimants. In other cases, a company may prefer to“self-insure” and another party may process claims received fromclaimants. In still other circumstances, a company might want to processsome claims under an insurance policy while other claims areself-insured. Implementing such a hybrid approach, however, can be adifficult task for an insurer (e.g., in connection with issuesassociated with certificates of insurance, receiving collateral from thecompany, different rules and regulations in various states, etc.).

It would be desirable to provide systems and methods to provide riskrelationship resource allocation request servicing in a way thatprovides faster and more efficient results as compared to traditionalapproaches.

SUMMARY OF THE INVENTION

According to some embodiments, systems, methods, apparatus, computerprogram code and means are provided to provide risk relationshipresource allocation request servicing in a way that provides faster andmore efficient results as compared to traditional approaches and thatallow for flexibility and effectiveness when processing those requests.In some embodiments, a system may receive a first resource allocationrequest (associated with a first company) from a first entity. Thesystem may determine that the first request is not associated with arisk relationship and arrange for it to be processed via a claimservicing entity. Information about the first request may then be routedto a request handler device for processing and a communication with afirst graphical indication may be generated. The system may also receivea second resource allocation request (associated with the first company)from a second entity and determine that it is to be processed via arisk. The system may then route information about the second request toa request handler device for processing and generate a communicationwith a second graphical indication. Note that the request handler devicemay be the same device that received the information about the firstrequest.

Some embodiments comprise: means for receiving, by a computer processorof the back-end application computer server, a first resource allocationrequest from a first entity, the first resource allocation request beingassociated with a first company; means for automatically determiningthat the first resource allocation request is not associated with a riskrelationship between the enterprise and the first company; based on theautomatic determination, means for arranging for the first resourceallocation request to be processed via a claim servicing entity; meansfor routing information about the first resource allocation request to arequest handler device of the enterprise for processing; means forautomatically generating a first communication with a first graphicalindication in connection with the first resource allocation request;means for receiving a second resource allocation request from a secondentity, the second resource allocation request being associated with thefirst company; means for automatically determining that the secondresource allocation request is to be processed in accordance with a riskrelationship between the enterprise and the first company; means forrouting information about the second resource allocation request to arequest handler device of the enterprise for processing, wherein therequest handler device may be the same device that received theinformation about the first resource allocation request; and means forautomatically generating a second communication with a second graphicalindication in connection with the second resource allocation request,wherein the second graphical indication is different than the firstgraphical indication.

In some embodiments, a communication device associated with a back-endapplication computer server exchanges information with remote devices inconnection with an interactive graphical user interface. The informationmay be exchanged, for example, via public and/or proprietarycommunication networks.

A technical effect of some embodiments of the invention is an improvedand computerized way to provide risk relationship resource allocationrequest servicing in a way that provides faster and more efficientresults as compared to traditional approaches. With these and otheradvantages and features that will become hereinafter apparent, a morecomplete understanding of the nature of the invention can be obtained byreferring to the following detailed description and to the drawingsappended hereto.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a high-level block diagram of a traditional workers'compensation insurance arrangement.

FIG. 2 is a high-level block diagram of an arrangement using aThird-Party Administrator to service workers' compensation claims of aself-insured company.

FIG. 3 is a hybrid risk relationship resource allocation servicingarrangement in accordance with some embodiments.

FIG. 4 is a more detailed hybrid risk relationship resource allocationservicing system in accordance with some embodiments.

FIG. 5 illustrates a method according to some embodiments of the presentinvention.

FIG. 6 illustrates a cash call system in accordance with someembodiments.

FIG. 7 illustrates a cash call method according to some embodiments.

FIG. 8 is an information flow diagram in accordance with someembodiments.

FIG. 9 illustrates a payment processing system according to someembodiments.

FIG. 10 illustrates a payment processing method in accordance with someembodiments.

FIG. 11 is a block diagram of an apparatus in accordance with someembodiments of the present invention.

FIG. 12 is a portion of a tabular resource request database according tosome embodiments.

FIG. 13 is an example of a risk relationship resource allocation requestdisplay in accordance with some embodiments.

FIG. 14 illustrates an overall process in accordance with someembodiments.

DETAILED DESCRIPTION

The present invention provides significant technical improvements tofacilitate electronic messaging and dynamic data processing. The presentinvention is directed to more than merely a computer implementation of aroutine or conventional activity previously known in the industry as itsignificantly advances the technical efficiency, access, and/or accuracyof communications between devices by implementing a specific new methodand system as defined herein. The present invention is a specificadvancement in the area of electronic risk protection by providingbenefits in data accuracy (e.g., ensuring that resource allocationrequests are handled in an efficient and accurate fashion), dataavailability, and data integrity and such advances are not merely alongstanding commercial practice. The present invention providesimprovement beyond a mere generic computer implementation as it involvesthe processing and conversion of significant amounts of data, frommultiple sources, in a new beneficial manner as well as the interactionof a variety of specialized client and/or third-party systems, networks,and subsystems. For example, in the present invention information may beprocessed, updated, and analyzed via a back-end-end application serverto accurately improve processing of resource allocation requests, thusimproving the overall efficiency of the system associated with messagestorage requirements and/or bandwidth considerations (e.g., by reducingthe number of messages that need to be transmitted via the network).Moreover, embodiments associated with collecting accurate informationmight further improve risk values, predictions of risk values,allocations of resources, electronic record processing decisions, etc.

FIG. 1 is a high-level block diagram of a traditional workers'compensation insurance arrangement 100. A company 110 may enter a riskrelationship (e.g., a workers' compensation insurance agreement) with aninsurer 120. Details about the relationship may be stored in aninsurance policy data store 130 (e.g., a premium amount, terms andconditions, coverage information, etc.). Claim handlers 160 of theinsurer 120 may process resource allocation requests (e.g., insuranceclaims) as they received from claimants 170 (e.g., injured workers).

FIG. 2 is a high-level block diagram of an arrangement 200 using aThird-Party Administrator (“TPA”) 250 to service workers' compensationclaims of a “self-insured” company 210. As used herein, the phrase“self-insured” may refer to a risk management technique in which thecompany 210 sets aside a pool of money to be used to remedy anunexpected loss. That is, there is no risk relationship agreementbetween the company 210 and an insurer. Claim handlers 260 may processresource allocation requests from claimants 270. According to someembodiments, details about the arrangement 200 may be stored in anoptional contracts/service agreement repository 212 (e.g., Service LevelAgreement (“SLA”) details). Note that embodiments may be associated witha Self-Insured Retention (“SIR”) agreement which has a dollar amountspecified in a contract that must be paid by the company 210 before aninsurer will respond to a loss. Under an SIR contract, the company 210(rather than the insurer) would pay defense and/or indemnity costsassociated with a claim until the SIR limit was reached. After thatpoint, the insurer may make any additional payments for defense andindemnity that were covered by the over-arching excess policy.

In some cases, a company might want to use a traditional arrangement 100for some submitted claims while using a self-insured arrangement 200 forother submitted claims. For example, a company might want to utilize aself-insured approach for a headquarters while utilizing a traditionalinured-insurer approach for satellite offices located throughout thecountry. Implementing such a hybrid approach, however, can be adifficult task for an insurer. For example, SIR “bundled” claimadministration may be associated with a company that purchases a policywithout any claims management services. The insurer provides all otherpolicy management services including: filing coverage with the state,reporting claim data to various reporting agencies, and reporting claiminformation with an applicable state government. The insurer may alsoissue certificates of insurance if the company needs them for customersor vendors. The insurer may mitigate its risk by requiring collateralfrom the company for the payment of claims (usually in form of a letterof credit). This may provide the insurer an asset to draw upon if thecompany's financial condition deteriorates (and it cannot pay losses).Also note that each state has different rules and regulations regardingthe administration of self-insured workers' compensation claims. Forexample, requirements in Electronic Data Interchange (“EDI”) states maybe complex making claims difficult to administer claims.

FIG. 3 is a hybrid risk relationship resource allocation servicingarrangement 300 in accordance with some embodiments. As in thetraditional approach 100, a company 310 may enter a risk relationship(e.g., a workers' compensation insurance agreement) with an insurer 320for certain employees or claims. Details about the relationship may bestored in an excess insurance policy data store 330 (e.g., a premiumamount, terms and conditions, coverage information, etc.). Claimhandlers 360 of the insurer 320 may process resource allocation requests(e.g., insurance claims) as they received from claimants 370 (e.g.,injured workers). In this arrangement, however, a claim servicing entity350 will service certain workers' compensation claims as a“self-insured” company 310. The claim handlers 360 may processself-insured resource allocation requests from claimants 370 for theclaim servicing entity 350 (e.g., the same claim handlers 360 thatprocess claims under the insurance policy). According to someembodiments, details about the arrangement 300 may be stored in anoptional contracts/service agreement repository 312. The claim servicingentity 350 may comprise, for example, a Limited Liability Company(“LLC”) with its own Tax Identification Number (“TIN”) and/or FederalEmployer Identification Number (“FEIN”).

FIG. 4 is a more detailed hybrid risk relationship resource allocationservicing system 400 in accordance with some embodiments of the presentinvention. In particular, the system 400 includes a back-end applicationcomputer server 450 (e.g., associated with an enterprise such as aninsurance company or claim servicing entity) that may access informationin a risk relationship data store 410 (e.g., storing a set of electronicrecords 412 representing risk relationships or associations, each record412 including, for example, one or more risk relationship or insurancepolicy identifiers 414, attribute variables 416, premium values 4148,etc.) and/or a resource request data store 420 (e.g., storing recordsassociated with workers' compensation insurance claims). The back-endapplication computer server 450 may also retrieve information from otherdata stores or sources—such as a company 432, a claimant 434, andthird-party data 436 (e.g., storing credit scores, communicationaddresses, motor vehicle information, or court records)—in connectionwith a request routing tool 455 and apply algorithms and/or models tothe electronic records (e.g., to help process insurance claims in anappropriate way). The back-end application computer server 450 may alsoexchange information with remote devices 460 (e.g., a workstation)associated with claim handler who process workers' compensationinsurance claims (e.g., via a communication port 465 that might includea firewall). According to some embodiments, an interactive graphicaluser interface platform of the back-end application computer server 450(and, in some cases, third-party data) may facilitate the display ofinformation associated with the request routing tool 455 via one or moreremote computers (e.g., to gather additional information about acontract, risk relationship, or resource allocation requests) and/or theremote device 460 s. For example, the remote devices 460 may transmitupdated information (e.g., an adjusted claim file) to the back-endapplication computer server 450. Based on the updated information, theback-end application computer server 450 may adjust data from the riskrelationship data store 410 or a resource request data store 420 andautomatically calculate and display updated values. Note that theback-end application computer server 450 and/or any of the other devicesand methods described herein might be associated with a cloud-basedenvironment and/or a third party, such as a vendor that performs aservice for an enterprise.

The back-end application computer server 450 and/or the other elementsof the system 400 might be, for example, associated with a PersonalComputer (“PC”), laptop computer, smartphone, an enterprise server, aserver farm, and/or a database or similar storage devices. According tosome embodiments, an “automated” back-end application computer server450 (and/or other elements of the system 400) may facilitate updates ofelectronic records in the risk relationship data store 410 and theresource request data store 420. As used herein, the term “automated”may refer to, for example, actions that can be performed with little (orno) intervention by a human.

As used herein, devices, including those associated with the back-endapplication computer server 450 and any other device described hereinmay exchange information via any communication network which may be oneor more of a Local Area Network (“LAN”), a Metropolitan Area Network(“MAN”), a Wide Area Network (“WAN”), a proprietary network, a PublicSwitched Telephone Network (“PSTN”), a Wireless Application Protocol(“WAP”) network, a Bluetooth network, a wireless LAN network, and/or anInternet Protocol (“IP”) network such as the Internet, an intranet, oran extranet. Note that any devices described herein may communicate viaone or more such communication networks.

The back-end application computer server 450 may store information intoand/or retrieve information from the risk relationship data store 410and/or resource request data store 420. The risk relationship data store410 might, for example, store electronic records representing aplurality of existing risk associations (e.g., workers' compensationinsurance policies), each electronic record having a set of attributevalues including a resource value (e.g., monetary amounts associatedwith premiums, deductibles, coverage limits, etc.). The data stores 410,420 may also contain information about prior and current interactionswith entities, including those associated with various companies 432 andclaimants 434. The risk relationship data store 410 and/or resourcerequest data store 420 may be locally stored or reside remote from theback-end application computer server 450. As will be described furtherbelow, the risk relationship data store 410 and/or the resource requestdata store 420 may be used by the back-end application computer server450 in connection with the request routing tool 455 to automaticallyguide insurance claim processing. Although a single back-end applicationcomputer server 450 is shown in FIG. 4 , any number of such devices maybe included. Moreover, various devices described herein might becombined according to embodiments of the present invention. For example,in some embodiments, the back-end application computer server 450, therisk relationship data store 410, and/or the resource request data store420 might be co-located and/or may comprise a single apparatus.

Note that the system 400 of FIG. 4 is provided only as an example, andembodiments may be associated with additional elements or components.According to some embodiments, the elements of the system 400automatically transmit information associated with a workers'compensation insurance claim over a distributed communication network.FIG. 5 illustrates a method 500 that might be performed by some or allof the elements of the system 400 described with respect to FIG. 4 , orany other system, according to some embodiments of the presentinvention. The flow charts described herein do not imply a fixed orderto the steps, and embodiments of the present invention may be practicedin any order that is practicable. Note that any of the methods describedherein may be performed by hardware, software, or any combination ofthese approaches. For example, a computer-readable storage medium maystore thereon instructions that when executed by a machine result inperformance according to any of the embodiments described herein.

At S510, a back-end application computer server of an enterprise (e.g.,an insurer) may receive a first resource allocation request (e.g., aworkers' compensation insurance claim) from a first entity (e.g., aclaimant), the first resource allocation request being associated with afirst company. At S520, the system may automatically determine that thefirst resource allocation request is not associated with a riskrelationship between the enterprise and the first company. Based on theautomatic determination, at S530 the system may arrange for the firstresource allocation request to be processed via a claim servicingentity. At S540, the system may route information about the firstresource allocation request to a request handler device (e.g.,associated with a workers' compensation insurance claim handler) of theenterprise for processing. At S550, the system may automaticallygenerate a first communication with a first graphical indication inconnection with the first resource allocation request (e.g., on a check,invoice, web page, video chat system, etc.).

At S560, the back-end application computer server may receive a secondresource allocation request from a second entity, the second resourceallocation request being associated with the first company. At S570, thesystem may automatically determine that the second resource allocationrequest is to be processed in accordance with a risk relationshipbetween the enterprise and the first company. At S580, the system mayroute information about the second resource allocation request to arequest handler device of the enterprise for processing. Note that therequest handler device may be the same device that received theinformation about the first resource allocation request. At S590, thesystem may automatically generate a second communication with a secondgraphical indication in connection with the second resource allocationrequest, wherein the second graphical indication is different than thefirst graphical indication. In this way, the system can help ensure thatthe party receiving the communication understands the role of theenterprise in the transaction.

According to some embodiments, the system may further include acommunication port coupled to the back-end application computer serverto facilitate a transmission of data with a remote device to support agraphical interactive user interface display via a distributedcommunication network. The interactive user interface display mayprovide information about processed resource allocation requests (e.g.,so that an operator or administration can review and/or adjust operationof the system).

In some embodiments, an excess risk relationship data store may containelectronic records that represent a plurality of excess riskrelationships between the enterprise and a plurality of companies. Eachelectronic record might include, for example, a relationship identifierand a set of attribute resource values associated with risk attributes.Similarly, a contract service agreement repository may containelectronic records that represent a plurality of service agreementsbetween the enterprise and the plurality of companies.

In this way, embodiments may provide a singular entity that handles bothnormal workers' compensation claims and self-insured claims in aseamless way. In this way, a single enterprise can utilize theknowledge, experience, and capacity to handle different types of claimsin an accurate and efficient way.

When a claim is handled as a “self-insured” type claim, the claimservicing entity might require that a company provide payment before theclaimant receives a benefit. That is, because there is no insurancepolicy associated with the claim, the claim servicing entity may want toavoid the risk of first paying the claimant and then being reimbursed bythe company (especially when the amount of payment is substantial. As aresult, FIG. 6 illustrates a cash call system 600 in accordance withsome embodiments. As before, the system 600 includes a back-endapplication computer server 650 (e.g., associated with a claim servicingentity) that may access information in a resource request data store 620(e.g., storing records associated with workers' compensation insuranceclaims). The back-end application computer server 650 may also retrieveinformation from other data stores or sources—such as a company 632 anda claimant 634—in connection with a claim routing tool 655 and a cashcall tool 656 and apply algorithms and/or models to the electronicrecords (e.g., to help process insurance claims in an appropriate way).The back-end application computer server 650 may also exchangeinformation with remote claim handler devices 660 (e.g., workstations).

At (A), a claimant 634 may submit a workers' compensation insuranceclaim to the back-end application computer server 650 and informationabout the claim may be stored into the resource request data store 620at (B). If the claim meets certain conditions (e.g., the claim isself-insured and associated with a value over a pre-determinedthreshold), the cash call tool 656 may request pre-payment from thecompany 632 at (C). Only after the company 632 pre-pays at (D), will theclaim servicing entity authorize the claim handler device 660 at (E) toprovide payment to the claimant 634.

FIG. 7 illustrates a cash call method 700 according to some embodiments.At S710, a first workers' compensation claim (associated with a firstcompany) may be received from a first claimant. At S720, it may bedetermined if the first workers' compensation claim is associated withan insurance policy. If so, the system processes the first workers'compensation claim and provides payment to the claimant at S760.

If there is no insurance policy at S720 (that is, the claim is“self-insured”), the system determines if the first workers'compensation insurance claim is over a pre-determined limit (e.g.,$100,000) at S730. If the claim is not over the limit at S730, thesystem processes the first workers' compensation claim and providespayment to the claimant at S760 (e.g., the amount of risk assumed by theclaim servicing entity is relatively small).

If the claim is over the limit at S730, the system requests payment fromthe first company at S740 (a “cash call”). Only after payment isreceived at S750, will the system process the first workers'compensation claim and provides payment to the claimant at S760 (e.g.,no risk is assumed by the claim servicing entity which has alreadyreceived payment).

FIG. 8 is an information flow diagram 800 in accordance with someembodiments. At 812, an insurance claim adjuster may use an AccountService Agreement (“ACA”) to understand specific cash call requirementsfor a large SIR handling. A billing analyst may be notified of a cashcall at 822 and enter timing and a cash value amount at 824. For pendingsettlements and/or groups of payments that need to be made above a cashcall threshold, the adjuster might transmit an email to a specialtybilling mailbox. The email might contain, for example:

-   -   an account name;    -   a cash call amount (the total the company should advance fund);    -   a service number;    -   a policy number;    -   policy effective dates;    -   a claimant;    -   a claim number; and    -   a date of loss.        A billing department may then issue a cash call invoice within a        pre-determined period of time (e.g., 1 business day) at 842. The        company will then have a period of time (e.g., 3 business days)        to execute an Electronic Funds Transfer (“EFT”) providing        payment to a billing lockbox at 832. When payment is received by        the billing analyst, the transaction type may be noted at 826        and payment may be remitted at 828. The billing analyst may then        email the adjuster that the cash has been received at 829 and        the adjuster may issue payment at 814. The cash call can then be        applied to the next invoice. For example, the billing department        may mark the payment as a cash call pre-payment at 844, and the        payment may be added to an invoice at 852 in connection with a        database system (e.g., a database system associated with        national accounts of an insurance enterprise). That invoice may        then be sent from the database system (854) and received by the        customer (834). Note that the invoice and/or other        communications may make the role the enterprise is performing in        the transactions clear (e.g., whether or not the enterprise is        acting as an insurer).

Since some workers' compensation claims might be handled under aninsurance policy while other claims are handled as “self-insured,” itmight be important for an enterprise to make it clear when it is (andwhen it is not) acting as an insurer. For example, FIG. 9 illustrates apayment processing system 900 according to some embodiments. As before,the system 900 includes a back-end application computer server 950(e.g., associated with a claim servicing entity) that may accessinformation in a resource request data store 920 (e.g., storing recordsassociated with workers' compensation insurance claims). The back-endapplication computer server 950 may also retrieve information from otherdata stores or sources—such as a claimant 934—in connection with a claimrouting tool 955 and a claim processing tool 956 and apply algorithmsand/or models to the electronic records (e.g., to help process insuranceclaims in an appropriate way). The back-end application computer server950 may then transmit payment checks, invoices, etc. as the claim isbeing processed.

At (A), a claimant 934 may submit a workers' compensation insuranceclaim to the back-end application computer server 950 and informationabout the claim may be stored into the resource request data store 920at (B). If the claim processing tool 956 determines that the claim isnot associated with a risk relationship, it may arrange to process atransfer 980 (e.g., a check or invoice) via a first graphical indication982 at (C). If the claim processing tool 956 determines that the secondfirst resource allocation request is to be processed in accordance witha risk relationship between the enterprise and first company, it mayarrange to process a transfer 990 via a second graphical indication 992at (D). The second graphical indication 992 may be different than thefirst graphical indication 982 (e.g., an might include a name, address,logo, etc.).

Note that either the first or second graphical indication might beassociated with an image, a logo, a processing party name, an address,contact information, etc., on a postal mailing, web site, videoconferencing background, or any other type of communication. Moreover,the determination that a resource allocation request is not associatedwith a risk relationship between the enterprise and the first company(or instead that it is in fact associated with such a relationship)might be based on a claimant identifier, a business rule, an algorithm,an automated analysis of a resource allocation request, etc.

FIG. 10 illustrates a payment processing method 1000 in accordance withsome embodiments. At S1010 the system may receive a first workers'compensation claim (associated with a first company) from a firstclaimant. If the first workers' compensation claim is not associatedwith an insurance policy at S1020 (that is, it is a “self-insured”claim), a transfer is processed via a first graphical indication atS1030. If the first workers' compensation claim is associated with aninsurance policy at S1020, a transfer is processed via a secondgraphical indication at S1040. In this way, an enterprise may make itclear when it is (and when it is not) acting as an insurer and avoidconfusion.

The embodiments described herein may be implemented using any number ofdifferent hardware configurations. For example, FIG. 11 illustrates anapparatus 1100 that may be, for example, associated with the system 400described with respect to FIG. 4 . The apparatus 1100 comprises aprocessor 1110, such as one or more commercially available CentralProcessing Units (“CPUs”) in the form of one-chip microprocessors,coupled to a communication device 1120 configured to communicate viacommunication network (not shown in FIG. 11 ). The communication device1120 may be used to communicate, for example, with one or more remoteclaim handler/customer computers and or communication devices (e.g., PCsand smartphones). Note that communications exchanged via thecommunication device 1120 may utilize security features, such as thosebetween a public internet user and an internal network of the insuranceenterprise. The security features might be associated with, for example,web servers, firewalls, and/or PCI infrastructure. The apparatus 1100further includes an input device 1140 (e.g., a mouse and/or keyboard toenter information about a company, a claimant, an insurance claim,insurance details, etc.) and an output device 1150 (e.g., to outputreports regarding works' compensation insurance claim processing).

The processor 1110 also communicates with a storage device 1130. Thestorage device 1130 may comprise any appropriate information storagedevice, including combinations of magnetic storage devices (e.g., a harddisk drive), optical storage devices, mobile telephones, and/orsemiconductor memory devices. The storage device 1130 stores a program1115 and/or a risk analysis tool or application for controlling theprocessor 1110. The processor 1110 performs instructions of the program1115, and thereby operates in accordance with any of the embodimentsdescribed herein. For example, the processor 1110 may receive a firstresource allocation request (associated with a first company) from afirst entity. The processor 1110 may determine that the first request isnot associated with a risk relationship and arrange for it to beprocessed via a claim servicing entity. Information about the firstrequest may then be routed to a request handler device for processingand a communication with a first graphical indication may be generated.The processor 1110 may also receive a second resource allocation request(associated with the first company) from a second entity and determinethat it is to be processed via a risk. The processor 1110 may then routeinformation about the second request to a request handler device forprocessing and generate a communication with a second graphicalindication. Note that the request handler device may be the same devicethat received the information about the first request.

The program 1115 may be stored in a compressed, uncompiled and/orencrypted format. The program 1115 may furthermore include other programelements, such as an operating system, a database management system,and/or device drivers used by the processor 1110 to interface withperipheral devices.

As used herein, information may be “received” by or “transmitted” to,for example: (i) the back-end application computer server 1100 fromanother device; or (ii) a software application or module within theback-end application computer server 1100 from another softwareapplication, module, or any other source.

In some embodiments (such as shown in FIG. 11 ), the storage device 1130further stores an excess risk relationship database 1160, a resourcerequest database 1200, and a service agreement database 1170. An exampleof a database that might be used in connection with the apparatus 1100will now be described in detail with respect to FIG. 12 . Note that thedatabase described herein is only an example, and additional and/ordifferent information may be stored therein. Moreover, various databasesmight be split or combined in accordance with any of the embodimentsdescribed herein. For example, the resource request database 1200 andthe excess risk relationship database 1160 might be combined and/orlinked to each other within the program 1115.

Referring to FIG. 12 , a table is shown that represents the resourcerequest database 1200 that may be stored at the apparatus 1200 accordingto some embodiments. The table may include, for example, entriesassociated with workers' compensation claims. The table may also definefields 1202, 1204, 1206, 1208, 1210 for each of the entries. The fields1202, 1204, 1206, 1208, 1210 may, according to some embodiments,specify: a resource allocation request identifier 1202, a claimantidentifier and amount 1204, a company identifier 1206, a processingdecision 1208, and a status 1210. The risk relation database 1200 may becreated and updated, for example, based on information electricallyreceived from various claimant computer systems, including thoseassociated with an insurer.

The resource allocation request identifier 1202 may be, for example, aunique alphanumeric code identifying (or a link to) a workers'compensation insurance claim (that might or might not be associated witha risk relationship such as an insurance policy). The claimantidentifier and amount 1204 might indicate a worker name or number and anamount associated with the claim. The company identifier 1206 mightidentify the insured and the processing decision 1208 might indicatewhether the claim is self-insured or covered under a workers'compensation insurance policy. The status 1210 might indicate thecurrent state of the claim (e.g., in process, approved, etc.). By way ofexample, because “RAR 10004” had processing decision 1208 of“self-insured” and the amount 1204 was substantial, the status 1210might comprise “awaiting cash call response.”

FIG. 13 is an example of a risk relationship resource allocationservicing system display 1300 in accordance with some embodiments. Thedisplay 1300 provides a graphical depiction 1310 of elements of a claimservicing entity framework to an operator via an interactive interfacethat allows the operator to adjust system components as appropriate. Forexample, selection of an item on the display 1300 (e.g., via atouchscreen or computer mouse pointer 1320) may let the operator seemore information about that particular item in a pop-up window and/oradjust operation of that item (e.g., by determining or over-riding thecurrent status of a workers' compensation insurance claim). According tosome embodiments, the display 1300 further includes a user-selectable“halt self-insured claim processing” icon 1330 that can be activated togenerate a resource allocation halt signal associated with a company.Responsive to the resource allocation halt signal, the system may flagfuture resource allocation requests associated with the company that arenot associated with a risk relationship between the enterprise and thecompany (while still processing claims covered under an insurancepolicy).

Thus, embodiments may provide an automated and efficient way to providerisk relationship resource allocation request servicing in a way thatprovides faster and more efficient results as compared to traditionalapproaches. Embodiments may enhance claim service to deliver more valueto customers and distribution partners with loss-sensitive workers'compensation exposures. Specifically, embodiments may handleself-insured workers' compensation claims for those customers who haveexcess workers compensation policies via a claim servicing entity. Inthis way, a similar claims experience to may be delivered to customerswith self-insured and loss-sensitive workers' compensation claims. Theability to offer self-insured, loss-sensitive workers' compensationclaims handling may enable an insurer to grow business and improveperception in the marketplace as it relates to broader appetite,innovation and flexibility. Additionally, companies may prefer to keeptheir traditional loss-sensitive and self-insured workers' compensationprograms together with the same claims administrator.

The following illustrates various additional embodiments of theinvention. These do not constitute a definition of all possibleembodiments, and those skilled in the art will understand that thepresent invention is applicable to many other embodiments. Further,although the following embodiments are briefly described for clarity,those skilled in the art will understand how to make any changes, ifnecessary, to the above-described apparatus and methods to accommodatethese and other embodiments and applications.

Although specific hardware and data configurations have been describedherein, note that any number of other configurations may be provided inaccordance with embodiments of the present invention (e.g., some of theinformation associated with the displays described herein might beimplemented as a virtual or augmented reality display and/or thedatabases described herein may be combined or stored in externalsystems).

Moreover, although embodiments have been described with respect toparticular types of insurance policies, embodiments may instead beassociated with other types of insurance policies or arrangements inadditional to and/or instead of the policies described herein (e.g.,general liability insurance, automobile insurance, etc.). FIG. 14illustrates an overall business process 1400 in accordance with someembodiments. At S1410, a hybrid workers' compensation relationship maybe established between an insurer and a company. At S1420, workers'compensation insurance claims may be received from claimants. Theseclaims may then be processed (including both self-insured claims andinsured claims) using the same pool of claim handlers at S1430. AtS1440, the insurer (and/or claim servicing entity) may make cash callsand adjust image indications (e.g., on checks and invoices) asappropriate. At S1450, payments may be provided to claimants as theworkers' compensation insurance claims are processed.

The present invention has been described in terms of several embodimentssolely for the purpose of illustration. Persons skilled in the art willrecognize from this description that the invention is not limited to theembodiments described, but may be practiced with modifications andalterations limited only by the spirit and scope of the appended claims.

What is claimed:
 1. A system to provide resource allocation requestservicing for risk relationships via a back-end application computerserver of an enterprise, comprising: (a) the back-end applicationcomputer server including: a computer processor, and a computer memorycoupled to the computer processor and storing program instructions that,when executed by the computer processor, cause the back-end applicationcomputer server to: (i) receive a first resource allocation request froma first entity, the first resource allocation request being associatedwith a first company, (ii) access a plurality of records in a riskrelationship data store associated with an encrypted database managementsystem, (iii) in response to the access, automatically determine thatthe first resource allocation request is not associated with a riskrelationship between the enterprise and the first company, thedetermination based on the back-end application computer serveraccessing a plurality of records in the risk relationship data store anddetermining at least one identifier associated with the request isabsent from the risk relationship data store, (iv) based on theautomatic determination, arrange for the first resource allocationrequest to be processed via a claim servicing entity, wherein resourceallocation requests that are determined to be associated with the riskrelationship between the enterprise and the first company are notprocessed via the claim servicing entity thereby reducing a number ofelectronic messages transmitted via a distributed communication network,(v) route information about the first resource allocation request to arequest handler device of the enterprise for processing, (vi)automatically generate a first communication with a first graphicalindication in connection with the first resource allocation request,(vii) receive a second resource allocation request from a second entity,the second resource allocation request being associated with the firstcompany, (viii) automatically determine that the second resourceallocation request is to be processed in accordance with a riskrelationship between the enterprise and the first company, (ix) routeinformation about the second resource allocation request to a requesthandler device of the enterprise for processing, wherein the requesthandler device may be the same device that received the informationabout the first resource allocation request, and (x) automaticallygenerate a second communication with a second graphical indication inconnection with the second resource allocation request, wherein thesecond graphical indication is different than the first graphicalindication; and (b) a communication port coupled to the back-endapplication computer server to facilitate a transmission of data with aremote device to support a graphical interactive user interface displayvia security features of a distributed communication network, theinteractive user interface display providing information about processedresource allocation requests.
 2. The system of claim 1, furthercomprising: (c) the risk relationship data store containing electronicrecords that represent a plurality of excess risk relationships betweenthe enterprise and a plurality of companies, wherein each electronicrecord includes a relationship identifier and a set of attributeresource values associated with risk attributes.
 3. The system of claim2, further comprising: (d) a contract service agreement repositorycontaining electronic records that represent a plurality of serviceagreements between the enterprise and the plurality of companies.
 4. Thesystem of claim 1, wherein the back-end application computer server isfurther programmed to: after determining that the first resourceallocation request is not associated with a risk relationship, detectthat the first resource allocation request is associated with a valueabove a pre-determined threshold value and, responsive to thisdetection, request an advance resource transfer from the first company.5. The system of claim 4, wherein the back-end application computerserver is further programmed to: upon completion of the advance resourcetransfer from the first company, arrange a resource transfer to thefirst entity.
 6. The system of claim 1, wherein said first graphicalindication is associated with at least one of: (i) an image, (ii) alogo, (iii) a processing party name, (iv) an address, and (v) contactinformation.
 7. The system of claim 1, wherein said determination thatthe first resource allocation request is not associated with the riskrelationship between the enterprise and the first company is based atleast in part on: (i) a claimant identifier, (ii) a business rule, (iii)an algorithm, and (iv) an automated analysis of the first resourceallocation request.
 8. The system of claim 1, wherein the enterprisecomprises an insurer, the first and second entities are claimants, andthe resource allocation request is a workers' compensation insuranceclaim.
 9. The system of claim 8, wherein the request handler device isassociated with an insurance claim handler.
 10. The system of claim 1,wherein the back-end application computer server is further to: receivea resource allocation halt signal associated with the first company, andresponsive to the resource allocation halt signal, flag future resourceallocation requests associated with the first company that are notassociated with a risk relationship between the enterprise and the firstcompany.
 11. A computerized method to provide resource allocationrequest servicing for risk relationships via a back-end applicationcomputer server of an enterprise, comprising: receiving, by a computerprocessor of the back-end application computer server, a first resourceallocation request from a first entity, the first resource allocationrequest being associated with a first company; accessing a plurality ofrecords in a risk relationship data store associated with an encrypteddatabase management system; in response to the access, automaticallydetermining that the first resource allocation request is not associatedwith a risk relationship between the enterprise and the first company,the determination based on the back-end application computer serveraccessing a plurality of records in the risk relationship data store anddetermining at least one identifier associated with the request isabsent from the risk relationship data store; based on the automaticdetermination, arranging for the first resource allocation request to beprocessed via a claim servicing entity, wherein resource allocationrequests that are determined to be associated with the risk relationshipbetween the enterprise and the first company are not processed via theclaim serving entity, thereby reducing a number of electronic messagestransmitted via a distributed communication network; routing informationabout the first resource allocation request to a request handler deviceof the enterprise for processing; automatically generating a firstcommunication with a first graphical indication in connection with thefirst resource allocation request; receiving a second resourceallocation request from a second entity, the second resource allocationrequest being associated with the first company; automaticallydetermining that the second resource allocation request is to beprocessed in accordance with a risk relationship between the enterpriseand the first company; routing information about the second resourceallocation request to a request handler device of the enterprise forprocessing, wherein the request handler device may be the same devicethat received the information about the first resource allocationrequest; and automatically generating a second communication with asecond graphical indication in connection with the second resourceallocation request, wherein the second graphical indication is differentthan the first graphical indication.
 12. The method of claim 11, furthercomprising: after determining that the first resource allocation requestis not associated with the risk relationship, detecting that the firstresource allocation request is associated with a value above apre-determined threshold value and, responsive to this detection,requesting an advance resource transfer from the first company.
 13. Themethod of claim 12, wherein the back-end application computer server isfurther programmed to: upon completion of the advance resource transferfrom the first company, arranging a resource transfer to the firstentity.
 14. A non-tangible, computer-readable medium storinginstructions, that, when executed by a processor, cause the processor toperform a method to provide resource allocation request servicing forrisk relationships via a back-end application computer server of anenterprise, the method comprising: receiving, by a computer processor ofthe back-end application computer server, a first resource allocationrequest from a first entity, the first resource allocation request beingassociated with a first company; accessing a plurality of records in arisk relationship data store associated with an encrypted databasemanagement system; in response to the access, automatically determiningthat the first resource allocation request is not associated with a riskrelationship between the enterprise and the first company, thedetermination based on the back-end application computer serveraccessing a plurality of records in the risk relationship data store anddetermining at least one identifier associated with the request isabsent from the risk relationship data store; based on the automaticdetermination, arranging for the first resource allocation request to beprocessed via a claim servicing entity, wherein resource allocationrequests that are determined to be associated with the risk relationshipbetween the enterprise and the first company are not processed via theclaim servicing entity thereby reducing a number of electronic messagestransmitted via a distributed communication network; routing informationabout the first resource allocation request to a request handler deviceof the enterprise for processing; automatically generating a firstcommunication with a first graphical indication in connection with thefirst resource allocation request; receiving a second resourceallocation request from a second entity, the second resource allocationrequest being associated with the first company; automaticallydetermining that the second resource allocation request is to beprocessed in accordance with a risk relationship between the enterpriseand the first company; routing information about the second resourceallocation request to a request handler device of the enterprise forprocessing, wherein the request handler device may be the same devicethat received the information about the first resource allocationrequest; and automatically generating a second communication with asecond graphical indication in connection with the second resourceallocation request, wherein the second graphical indication is differentthan the first graphical indication.
 15. The medium of claim 14, whereinsaid first graphical indication is associated with at least one of: (i)an image, (ii) a logo, (iii) a processing party name, (iv) an address,and (v) contact information.
 16. The medium of claim 14, wherein saiddetermination that the first resource allocation request is notassociated with a risk relationship between the enterprise and the firstcompany is based at least in part on: (i) a claimant identifier, (ii) abusiness rule, (iii) an algorithm, and (iv) an automated analysis of thefirst resource allocation request.
 17. The medium of claim 14, whereinthe enterprise comprises an insurer, the first and second entities areclaimants, and the resource allocation request is a workers'compensation insurance claim.
 18. The medium of claim 17, wherein therequest handler device is associated with an insurance claim handler.19. The medium of claim 14, wherein the method further comprises:receiving a resource allocation halt signal associated with the firstcompany, and responsive to the resource allocation halt signal, flaggingfuture resource allocation requests associated with the first companythat are not associated with a risk relationship between the enterpriseand the first company.
 20. The medium of claim 14, wherein the back-endapplication computer server exchanges information with at least one of:(i) an excess risk relationship data store, and (ii) a contract serviceagreement repository.